Oyewale Tomori, a Professor of Virology, President Nigerian Academy of Science and Chairman Expert Review Committee on Polio Eradication and Routine Immunisation, reviews the Polio eradication efforts of government.
This month – July – was a very auspicious month for Nigeria in 2014. Two health related occurrences took place in that month. On Sunday July 20 2014, Patrick Sawyer flew into Lagos airport, a sick man with Ebola Virus Disease.
He died five days later, but not before infecting other people – his primary contacts -health workers who took care of him and who subsequently infected other people.
On July 24, 2014, a day before Patrick Sawyer died, a one year old child in Sumaila LGA of Kano State had an onset of a disease later confirmed to be polio. This has been the last polio case confirmed in Nigeria for the past one year.
Never has Nigeria gone on for so many months (12 months) without reporting at least one case of polio. The last time we went free of polio was for only 3 months between May and July 2014. If we get our acts together and maintain zero polio case until the end of July 2015, the Nigeria will be removed from the list of polio endemic countries, that is, countries that have never interrupted polio transmission. Do not expect WHO to remove out country from the ignoble list of polio endemic countries, until another late August or early September 2015, by which time all of the samples collected on or before 24 July this year, would have been tested and found negative for polio. Delisting from polio endemic countries is only a step towards Nigeria being declared a polio free nation. This will only happen if we report no polio case for another 2 years, that is, after July 2017. So let us not bring out the drums and the palm wine tumblers in premature celebrations.
During the five year period between 2005 and 2009, the total number of reported polio cases in Africa was 4,039 and Nigeria alone accounted for 3,729 (92%) of the African cases. This number is far above our contribution to Africa’s population- I think we boast that there is a Nigerian for every five Africans; this time Nigeria was contributing more than 9 out of every 10 polio cases in Africa. In addition to the sub-optimal performance of the national immunization programme and the poor routine immunization coverage, the main stimulus for our poor performance was the call in 2003, for the boycott of anti-polio vaccination in northern states because of suspected contamination of the polio vaccine with anti-fertility steroids.
The resulting boycott brought a wobbling national polio eradication programme to a total collapse as the average annual number of reported polio cases increased from 400 (between 1998 and 2002) to 750 cases after the call. Frantic national and international efforts were made to end the boycott. This included the adoption of a resolution in 2008 at the 61st WHA, calling on Nigeria to reduce the risk of international spread of poliovirus by ensuring that all children in the north of the country are vaccinated against polio. This special mention of Nigeria – a naming and shaming- at a global level, appear to have moved Nigeria in the right direction for achieving polio eradication, a series of activities, including a change in the leadership of the agency charged with polio eradication in Nigeria, engagement of traditional and community leaders, civil society organizations, women groups, and encouraging the community to “own” the eradication initiative began to yield positive results.
These activities were further strengthened by ensuring adequate and efficient implementation of detailed immunization micro plans, improved monitoring of staff and their activities through the use of modern communication gadgets and systems. Another input that enhanced the performance on the field included the institution of an accountability frame work for all stakeholders and partners (federal and state governments, LGAs, international development partners, NGOs, and members of the community). Individuals, not the system or the organization were held responsible and accountable for their performance – commending good performance and sanctioning poor performance at each and every level.